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  1. Hey all, I have been a PA for 9 years now (1yr cardiac sx, 4yrs EM, 4yrs ortho hand) and just took a new position about one year ago in a new specialty. I went from Hand surgery/upper extremity ortho to ENT. I have a good salary and when I started, the bonus structure was TBD as I am their first APP. My position is unique as they wanted a PA to help offload consults and hospital rounds in the afternoon so the on call physician doesn't get stuck doing everything after their day. I typically see patients in the morning and occasionally in the afternoon (only until about 230pm to allow for time to go to the various hospitals depending on what has come in for the day). Sometimes I am super busy in the afternoon and cannot get to everything (but I leave around 5pm, although, some weeks my days are longer, regardless) and other times there isn't much to do and I will help out one of the docs with their PM clinic or catch up on patient phone calls, notes, etc. LSome weeks I am bored in the afternoon but they want me to be 'available.' I help out in surgery, but rarely, despite 5yrs of OR experience. I was completely new to ENT, so, to some extent, I had to be taught a lot this past year, however, on the other hand, I have lots of experience with abscess drainage, hospital familiarity, etc, so, a lot of things did not have to be taught. I just had my annual review and I have received pretty much all positive remarks. They are thrilled to have a PA and wonder why they didn't hire one sooner. They are a pretty old school private practice, so, a lot of the physicians don't prefer me to first assist them in the OR (they help each other out), which would be another way for me to make $$ for the practice. For this past year, they have given me a 5k bonus (I'm ok with that given my learning curve). I currently make 105k for 4.5d a week, plus $1800 cellphone reimbursement, laptop, and 4 weeks vacation. We discussed a bonus structure moving forward and I was asked what I thought was an appropriate bonus. I said 5-10% annually. I have my numbers, also, and in just 3 quarters, I have almost earned my salary and I am projected to pay for myself in charges with a full year of work, despite some afternoons not having much to do and having to train office staff that I am a provider and how to schedule me patients, etc. The issue is, they want to provide a bonus quarterly based on 'how they think I'm doing." There will be a low tier, middle tier, and high tier. They said most of the time, the expectation is that I will probably get middle tier $$ and usually only reach the highest tier if I seem to have an exceptional quarter. They also said putting in more face time with the physician partners in the office to 'help them out' in the afternoon when I'm not busy in a hospital can be a real boost. Some of our docs love it when I help and other docs don't seem to really want a PA in their office flow...they are used to doing everything themselves and it is awkward. The issue is, I am not entirely comfortable with the idea of my bonus being based solely on subjective opinions of the partners. Some seasons are busier than others with the number of consults that come in and while I try to see everything that we get, sometimes I physically cannot make it to 4 different hospital facilities in an afternoon (for consults ranging from epistaxis management to abscess drainage to trach care). When I asked about a bonus based on productivity, however, they said they don't want to incentivize my office productivity because they care more about me being available to help out in the hospital to offset having to see consults after their main office day. I just have no control over the subjective opinions of the physicians and I also don't have control over what comes in from the hospitals. They are open to ideas, but, I don't have any. Can anyone provide any sort of alternative bonus structure? THANKS!
  2. hi, yes, sometimes I feel like that, however, I do see patients (although a limited amount) and do see consults in the hospital and perform procedures as necessary...but in the office setting, yes, they want me to be the PA/MA/nurse, etc. they literally pay me to sit on hold and precert my own CT scans that I order. crazy.
  3. I have been there since April of this year. This is a well-established private practice (40yrs old) that is affiliated but not owned by a larger hospital group. Some of the docs in the group know that I feel that I don't have much to do. I have also communicated that to the president of the practice with concerns that I don't think shadowing in the afternoon is a sustainable use of my time. He didn't really address that however, he reiterated how wonderful I am because I am able to see consults when they are on call (making them not have to go see them at the end of their clinic day). Honestly, part of me thinks that they hired me because they don't like their call burden, but didn't really think how else to utilize me other than that. I'm not sure he really gets that sometimes, I don't do ANYTHING. Lately, I have stopped showing up in the afternoon clinics to shadow if there is nothing "interesting" or different on the schedules because I just don't want to follow someone around. I stay in the hospital physician lounge or in the doc's room in the office unless someone specifically asks me to be present somewhere. I'm not saying I know everything, but, also, it gets REALLY BORING to follow someone around. One of the higher up partners and I also had conversation about boosting my #s and I explained to him things I was doing to try to increase productivity and also asked to be in the OR more in order to boost my charges. He stated that the physicians are less likely to have me in the OR because even when they first assist each other, they get credit towards their productivity and so it doesn't give them an incentive to give up their assist time either. They hired a new physician at the same time as they hired me, plus, it seems to be a slow time of the year, which complicates things even more. The practice manager can be tricky... I have worked in another private practice and I know from experience that you have to be careful about what you say to them because you have to remember, they are paid by the partners of the group. I do not trust that they hold anything I say in confidence, so, I do not plan to lay everything out to her unless I am really ready to speak to the physicians about it. I just don't know how to change the situation...it's like they want an PA but they didn't necessarily think it through all the way.
  4. Hourly is nice, but, often in an office type setting that isn't always a specific shift, it can be problematic. question: do you clock in and out? keeping track of hours in a non-shiftwwork (like an ED) type position is kind of exhausting. I did it when I temporarily went part time and it was annoying. At first, I clocked in and out which I hated, but, still had to keep track of hours at different locations, and when going to hospitals, etc. Plus, if there is downtime, being a salaried employee can be beneficial (as long as you are happy with your pay and have a solid bonus structure in place). That way, you can just finish your work (patients for the day) and get out of there instead of feeling that maybe you should 'stay later to get a certain # of hours in a day,' etc. As an example, you can set your schedule so you see a certain # of patients during the week and make your Fridays nicer so you can finish a bit early to get the weekend started. You don't want to feel like you have to stay there to make a certain # of hours to get a certain $$ amount on your paycheck. You should just negotiate for the highest salary you feel you are worth for the expected hours, etc. If things change, then re-negotiate.
  5. thanks for your insight. I guess I am just an overachiever who feels like they have to be busy and have a purpose all day vs. someone who is ok having a lot of downtime at work with nothing to do. I feel my job is secure at this point, however, I do wonder if at some point they will do the numbers and realize I'm not paying for myself. One of the partners said they did not hire me for those reasons, but, when push comes to shove...$$ talks. The partners don't have a clear plan for me...(I keep hearing different ideas from different docs about what they want me to do, etc)with the exception of me covering their consults so they don't have to spend more time at night away from their families. I guess if I do point out what I'm (not) doing, and they think continuing to shadow a physician in my afternoons is reasonable, I will have to get out of there...it just isn't worth my time to follow someone along. It is just plain boring and I have too many skills (surgical, in-office procedural, knowledge of post-op care management, acute care) to just watch someone else work. I have never been in this position before and I want to give it a chance, but, alternatively, if this doesn't pick up....I don't think I can see myself there long term. I just want to be productive work.
  6. I want to bounce this off of you all. I am a PA with 9 years experience in CT surgery, EM, Ortho, and Hand surgery. I took a new position with ENT close to home about 6 months ago because I needed a shorter commute. Everything seemed great when I took the position, however, I have some issues. They are a male dominated super conservative practice who have never had an APP. 1. I am their first PA and they don't seem to know how to effectively utilize me despite my suggestions. They mainly hired a PA because they want me 'available' in the afternoon to see consults at our 4 hospitals to help off load the on-call doc. (they hate going to see consults after their office day) Which seemed fine initially, however, when consults don't come in, I have nothing to do. The physicians use up all of the afternoon office space so there is no space for me to have an office (unless someone is out). Initially, I was shadowing the different physicians, but that is getting super old, super quick. I am bored and hate just shadowing. Sometimes there are 2 or 3 consults to see which keeps me busy, however, a lot of times, just one or none in a day. 2. I do have the ability for a morning clinic, however, my schedule isn't booking up. I get anywhere from 1-3 patients max in a morning. The physicians don't want me seeing anything surgical and typical cerumen impactions and acute things are supposed to go on my schedule, however, the patients continue to request the MDs (or MDs aren't booked fully so they prefer to have the patient go to them). So, my mornings are slow. I typically help round after my patients are seen, but, it's just so...SLOW. I email the doc's nurses and our front desk staff weekly to let them know of my open schedule and usually nothing changes. One morning, a doc even asked to see all of my (2) patients because he was slow. He stated it was so he could bill for them and get the 100% reimbursement (for the practice) vs. the 85% if I just saw them....because it is a slow time for the practice. It was super annoying...why was I even there then? 3. They also don't have a medical assistant for me or support staff, which is fine now, because I'm not busy, but they want me to precert all of my own tests, etc, which I think is a misuse of my time. I mean...if they want to pay me a PA salary to sit on hold with an insurance company...so be it...but, I just think it is stupid. 4. They do not utilize me in surgery. I have 5+yrs of surgery experience and I have probably been in the OR 6 times since I started because the docs prefer to assist each other for thyroidectomies, parathyroids, parotids, etc. I keep telling them that I am available and want to help, but they are super conservative and seem to prefer each other vs. me. Overall, I'm used to being busy and feeling useful. I try to help out in the docs clinics, but, I end up just shadowing and it is driving me nuts. Lately, I have been just going home for part of the afternoon (or sitting in the hospital doc lounge) and coming back to the hospital if I'm called unless a specific doc asks me my plans for the afternoon. I feel that is unethical, but, I absolutely cannot stand sitting around. I am seriously thinking about going back to ortho...I have a ton of contacts in the ortho world and I know I will be utilized well in that specialty. any thoughts on how to talk to this group? I know they would be super disappointed if I resigned (they keep saying I'm wonderful and great....and they want me there forever) but, I also am at a loss about how to change things. I am bored and somewhat uninterested...It was a risk to change specialties...and I know it sometimes takes awhile...but, are these normal 'growing pains' or when should I look elsewhere? Thanks in advance!
  7. Thank you for the response. The new practice is getting me established with payers. I think I will recommend to just bill under my name. It just seems like the most direct way and there is no question if it's right or wrong. As for the other practice, I don't think I was committing fraud because I was actually seeing every patient with the physician....hence why I left. They didn't utilize PAs appropriately.
  8. Hello, I just joined an otolaryngology practice and I am their first PA. I have been in practice for 9 years, but, embarrassingly enough, I have limited knowledge of billing. My previous ortho practice did not share any information about billing and basically, all of my dictations had to say "I am dictating as a scribe on behalf of Dr. Soandso." I had minimal autonomy and had no access to any collections and never had my own clinic. My experience prior to that was working in the ED for a large public university and we never really talked about collections or billing. With this new practice, I will be in clinic (eventually my own clinic time without a physician in the same locale) and I will spend some time first assisting in the OR. The practice is essentially asking how to bill for me, as they have never had a PA. I know the reimbursement is usually 85% for a PA from Medicare and a lot of other carriers. I also know that a lot of practices bill under a physician's name to get the full 100% (incident-to). I will be seeing a mix of new and established patients in clinic, doing a fair amount of procedures, etc. Obviously, the practice wants to make as much money as possible and are asking me specifics on Incident-to, etc. I have read a lot about it and it sounds pretty complicated and specific. Are there any other ways to bill under a physician other than incident-to? I feel it just may be best, to avoid confusion and error, to just bill under my own name for most things....unless I specifically have a doc come in and examine the patient with me. Is this typical or do a lot of PAs still bill under a physician's name? A friend of mine who works in pediatrics just told me that her practice bills under the physician's name for her patients almost exclusively....but I don't really see how that is possible when she is in a separate local from her supervising physician. Am I missing something? They are sending me to a billing and coding seminar in August, but, we are trying to get some things figured out, as I have started seeing consults in the hospital already (I'm still training in clinics with the docs) and I will be seeing patients autonomously in clinic in the next month or so. The practice has a consultant that they frequently use, but, she seemed a little unaware of the exact rules, too. Can anyone help me or at least point me in the right direction? Thanks!
  9. Hey, does anyone know what the specific regulations are for KY with regards to this language in the statutes: 'A physician assistant shall not submit direct billing for medical services and procedures performed by the physician assistant.' I'm the first PA in a moderately sized ENT group and the biller has questions pertaining to that statement. Do I always have to be billed under the physician? I will be running my own clinic when I'm trained...do they always have to bill under the docs? Also, does anyone know what percentage of charts need to be signed by the SP? The language in the legislation is quite vague. Thanks!!
  10. I got the job and desired salary for my location. I used AAPA salary report. starting 105k plus bonus, annual review with expected increase depending on how i'm doing, 1800k a year for cell reimbursement, fully paid licensure, CME, DEA. Overall, I'm pretty happy with it. As I gain experience in ENT, I hope to steadily increase my salary over time. Thanks everyone for your thoughts.
  11. This is a GREAT post. Should be sent to all soon-to-be graduates at PA schools!
  12. Thanks everyone!! This is a fantastic set of responses and I will print them out to keep for later. I read some of this info after I had already replied to the HR email....however, I stood my ground and asked for $110k. I was pretty general about my past compensation history. I am the first PA they will have had (hopefully...if I get the job). She called back and asked other questions such as my typical weeks vacation, past CME, etc. I really think they are trying to put together a package and dont know where to start. The salary I asked for would be a huge jump for me and I feel it is on the higher side for my area for non-ED and urgent care type of work. Hopefully, I will hear something soon!!! Any tips for non-negotiables I shouldn't forget if they come back with an offer? In my head I have malpractice coverage, licensure and society fees, vacation, cme, bonus structure, maternity policy, cell phone reimbursement....
  13. gosh, I'm underpaid. I knew I was...but, I haven't found anything better. I'm in Northern KY and Southern OH. I'm hesitant to respond to the email with my current salary because it is so low (given my circumstances)! I don't like that they asked for my salary history...but, this is the first PA the group has hired. I just don't want to answer that question.
  14. Hello, In salary negotiations, do you specifically give a salary expectation and salary history or wait for them to give you an offer? I am a PA who has 8 (almost 9!) years of experience in Emergency Medicine, limited CT surgery, and most recently, upper extremity Ortho and Hand. I have had 2 interviews and shadowed with a private ENT/allergy practice with 8 ENTs who are very interested in hiring a PA (not NP..yay!) for the first time. They want someone who has experience with procedures, rounding in hospital, seeing consults, but not necessarily for OR, which is fine with me. They offer autonomy after the training period...which would be awesome. There are some wrinkles to iron out, however, they seem to have a good idea of what they want their new PA to do, etc. They even want to send me to the ENT for PA conference in April to get acquainted. Overall, I'm ready to take the job....BUT...we haven't discussed salary yet. They emailed me to say they are very interested and asked for my salary history and salary requirements. I'm hesitant to share with them my history because currently, I feel somewhat underpaid for my years of experience with my current practice (in my 5th year of ortho, 8.5yrs total as a PA). Here are my stats: I make 93k full time and I got a $2500 bonus. I haven't had an increase since Jan of 2014 and my doc has been dragging his feet for any increase at all, despite telling be I do great and he wouldn't know what to do without me. I have given him salary reports, asked for a 7% increase (to cover the last 3yrs), etc, which I think is still on the low side. I'm just not his priority and I have been looking to get out for a year now...I just came back from Maternity leave. We are still in limbo despite HR and myself approaching him about the issue. This specific job sounds great. I want at least 100k, plus bonus. I don't think that is unreasonable, given the reimbursement for ENT, my years experience, etc. I feel that if I tell them what I currently make, they will not want to offer a lot more than that. Any thoughts!? Sorry so long!
  15. These posts are awesome.....and helpful. I am 8 years in practice, the first 4 in EM (which were great and I was truly respected), and the last 4 in ortho (made a hasty switch to get out of nights and weekends) where unfortunately, I fall into a number of these categories. My gut has been telling me it's not right for years, I just haven't found the right fit elsewhere (currently pregnant but looking)! This board has been quite helpful and I am almost ashamed to say that I have put up with some of those bullets for a long time, knowing it was BS, but afraid to make a change. I am coming around and moving in a positive direction. THANKS!
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